Healthcare Provider Details

I. General information

NPI: 1124040134
Provider Name (Legal Business Name): MAURICE GERALD SHOLAS MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FERRY RD 1532 TULANE AVENUE
ATLANTA GA
30342
US

IV. Provider business mailing address

1001 JOHNSON FERRY RD
ATLANTA GA
30342
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-3800
  • Fax: 404-785-3808
Mailing address:
  • Phone: 404-785-3800
  • Fax: 404-785-3808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number15781R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: